If you're confused by the news reports and you're wondering how the pieces fit together and where things stand, I'll try to keep this page updated as events unfold.
ACA repeal: what happens next?
Politico reporter Dan Diamond posted this ACA repeal checklist on Twitter. I've modified it slightly to better reflect the full scope of what's happening when.
But don't forget, "ACA repeal" in this context is only a partial repeal, which will set up a "death spiral" in health insurance markets and raise costs for all of us. (Read my backgrounders on what the GOP can and can't do through reconciliation here and on the politics of their replacement plans here.)
☑ Senate vote-a-rama on amendments to budget outline
☑ Senate passes budget outline
☑ House passes budget outline
☐ House drafts reconciliation bill repealing parts of the ACA, cutting taxes on the .01% wealthiest Americans, and blocking women with Medicaid from going to Planned Parenthood**
☐ House votes on repeal bill and sends it to the Senate
☐ Senate debates repeal bill, holds vote-a-rama on amendments
If Senate adopts any amendments:
☐ Senate votes on repeal bill (only 50 senators needed for passage; VP Pence can cast 51st vote)
☐ Conference committee works out the differences between House and Senate versions, then either House or both House and Senate must vote again
☐ Trump signs ACA partial repeal/attack on PP patients into law
If Senate does not adopt any amendments:
☐ Senate votes on repeal bill (only 50 senators needed for passage; VP Pence can cast 51st vote)
☐ Trump signs ACA partial repeal/attack on PP patients into law
**A quick note
a) We can't forget that the repeal bill will also be a massive tax cut for the ultra-wealthy.
b) The right wing has called for "defunding Planned Parenthood," which falsely implies that Planned Parenthood gets some kind of special kickback from the government. In reality, Planned Parenthood provides health services and gets reimbursed by health insurance plans, including government insurance plans like Medicaid and Medicare.
Whenever possible, I like to be clear that what Republicans are really doing is blocking people with government health insurance from using their insurance to get health care at Planned Parenthood clinics. Federal law already blocks federal dollars from going to abortions. The services that Medicaid and other government health insurance programs pay for are cancer screenings, STD treatments, family planning services like birth control, and more.
Republicans like to pretend that if they block Planned Parenthood, community health centers will be able to meet the demand. But public health experts have been pretty clear that this is absurd: "The assertion that community health centers could step into a breach of this magnitude is simply wrong and displays a fundamental misunderstanding of how the health care system works." And don't forget, we need look no further than Vice President Mike Pence's own Indiana for proof. As governor, Pence presided over a needle-borne HIV epidemic after he forced Planned Parenthood clinics in Indiana to close and there were no other providers to cover those lost services.
Looking beyond the ACA, what's next?
For anyone who wants the deep dive and the long-term picture, Congressional Quarterly made a chart which I've significantly modified (without permission, sorry) to reflect what has already happened and what Republicans have said is their timeline for the future.
Right now we're in the middle of the first of two rounds that Republicans hope to use to ram through their agenda. This first round (FY17) is a weird one, and very abbreviated from a normal budget resolution and reconciliation process. The second round (FY18)—if it actually occurs—is expected to follow a more traditional process, where committees in both the House and the Senate work on legislation, pass slightly different bills, and then conference them into one unified bill.
A major short-term goal for ACA supporters is to stop Congress from finishing this first round altogether so that they can't repeal parts of the ACA law or the taxes that pay for it.
But even if Republicans succeed in passing a partial ACA repeal, they'll have to grapple with chaos in health insurance markets—not to mention the political fallout from an immediate impact on Planned Parenthood's patients. So even if health reform takes a hit the short-term, I think it wins in the long-term.
At the same time, making this first round as painful as possible can stop the GOP from ever moving to the second round and the rest of their plans to gut the social safety net.
If they are successful in repealing the taxes on the wealthy included in the ACA, they won't have enough money to pay for a replacement package. That spells doom for high quality, affordable health care in this country.
But if they are successful in doing that second round of big tax cuts, everything is going to be starved for resources too, not just in health programs but in food safety and bridge inspections and air traffic control and highway improvements and clean energy research and...
See my first installment HERE on what Republicans can and can't do through reconciliation—and what that means for health care costs.
See my second installment HERE on the politics of Republican replacement plans.
ACA repeal: what happens next?
Politico reporter Dan Diamond posted this ACA repeal checklist on Twitter. I've modified it slightly to better reflect the full scope of what's happening when.
But don't forget, "ACA repeal" in this context is only a partial repeal, which will set up a "death spiral" in health insurance markets and raise costs for all of us. (Read my backgrounders on what the GOP can and can't do through reconciliation here and on the politics of their replacement plans here.)
☑ Senate vote-a-rama on amendments to budget outline
☑ Senate passes budget outline
☑ House passes budget outline
☐ House drafts reconciliation bill repealing parts of the ACA, cutting taxes on the .01% wealthiest Americans, and blocking women with Medicaid from going to Planned Parenthood**
☐ House votes on repeal bill and sends it to the Senate
☐ Senate debates repeal bill, holds vote-a-rama on amendments
If Senate adopts any amendments:
☐ Senate votes on repeal bill (only 50 senators needed for passage; VP Pence can cast 51st vote)
☐ Conference committee works out the differences between House and Senate versions, then either House or both House and Senate must vote again
☐ Trump signs ACA partial repeal/attack on PP patients into law
If Senate does not adopt any amendments:
☐ Senate votes on repeal bill (only 50 senators needed for passage; VP Pence can cast 51st vote)
☐ Trump signs ACA partial repeal/attack on PP patients into law
**A quick note
a) We can't forget that the repeal bill will also be a massive tax cut for the ultra-wealthy.
b) The right wing has called for "defunding Planned Parenthood," which falsely implies that Planned Parenthood gets some kind of special kickback from the government. In reality, Planned Parenthood provides health services and gets reimbursed by health insurance plans, including government insurance plans like Medicaid and Medicare.
Whenever possible, I like to be clear that what Republicans are really doing is blocking people with government health insurance from using their insurance to get health care at Planned Parenthood clinics. Federal law already blocks federal dollars from going to abortions. The services that Medicaid and other government health insurance programs pay for are cancer screenings, STD treatments, family planning services like birth control, and more.
Republicans like to pretend that if they block Planned Parenthood, community health centers will be able to meet the demand. But public health experts have been pretty clear that this is absurd: "The assertion that community health centers could step into a breach of this magnitude is simply wrong and displays a fundamental misunderstanding of how the health care system works." And don't forget, we need look no further than Vice President Mike Pence's own Indiana for proof. As governor, Pence presided over a needle-borne HIV epidemic after he forced Planned Parenthood clinics in Indiana to close and there were no other providers to cover those lost services.
Looking beyond the ACA, what's next?
For anyone who wants the deep dive and the long-term picture, Congressional Quarterly made a chart which I've significantly modified (without permission, sorry) to reflect what has already happened and what Republicans have said is their timeline for the future.
Right now we're in the middle of the first of two rounds that Republicans hope to use to ram through their agenda. This first round (FY17) is a weird one, and very abbreviated from a normal budget resolution and reconciliation process. The second round (FY18)—if it actually occurs—is expected to follow a more traditional process, where committees in both the House and the Senate work on legislation, pass slightly different bills, and then conference them into one unified bill.A major short-term goal for ACA supporters is to stop Congress from finishing this first round altogether so that they can't repeal parts of the ACA law or the taxes that pay for it.
But even if Republicans succeed in passing a partial ACA repeal, they'll have to grapple with chaos in health insurance markets—not to mention the political fallout from an immediate impact on Planned Parenthood's patients. So even if health reform takes a hit the short-term, I think it wins in the long-term.
At the same time, making this first round as painful as possible can stop the GOP from ever moving to the second round and the rest of their plans to gut the social safety net.
If they are successful in repealing the taxes on the wealthy included in the ACA, they won't have enough money to pay for a replacement package. That spells doom for high quality, affordable health care in this country.
But if they are successful in doing that second round of big tax cuts, everything is going to be starved for resources too, not just in health programs but in food safety and bridge inspections and air traffic control and highway improvements and clean energy research and...
***
See my first installment HERE on what Republicans can and can't do through reconciliation—and what that means for health care costs.
See my second installment HERE on the politics of Republican replacement plans.
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